Health Plan Perspective; Cambridge Health Alliance, Boston

My journey in Boston was completed with a visit to one of the large health insurers in the region, and to Cambridge Health Alliance, which serves Cambridge, Somerville, and Boston’s metro-north communities.

While in the area, I did manage to make a visit to the LEAN Enterprise Institute, where I was thrilled to meet James Womack, the author of several works that have shaped much of the work underway at Group Health and other health institutions. While at LEI, we talked about the penetration of LEAN into the health care space. Organizations in Boston are lucky to have access to this teaching and research resource so close by.

Health Plan Perspective: I visited with a physician in one of the region’s largest health insurers to learn more about the financing environment and its relationship to patient centered HIT work. As people in the field are aware, Massachusetts is home to the nationally recognized eHealth Collaborative, which is bringing 34 member organizations and pilot communities to support adoption of EHRs statewide. As the MAeHC web site, states, this is a $500 million proposition. In the discussion I participated in, two key questions arose from the plan perspective: 1. Who owns the personal health record? and 2. How and if will it be adopted? These are very helpful questions to keep in mind as we talk about innovations that require participation from a whole system (providers, patients, financing) to be successful. As I come from an environment where all are aligned within the same organization, it’s good to know what the key issues are. There will tension between interventions where ownership has been reasonably well established, such as disease management, and for which outcomes can be measured. Everyone wants to make investments that directly support beneficiaries. A recent article I read pointed out that there is much experimentation going in in the health plan sphere. The challenge, therefore, may be around focusing strategy toward PCHIT. The key questions mentioned may need to be answered to get us there, which is helpful to know.

Cambridge Health Alliance: The practice: My guide on my visit was Hilary Worthen, MD, Director of Medical Information Systems for CHA, and primary care practitioner for 25 years. Hilary and I did the thing I enjoy so much – walking through the community to understand it better, which brought us to Union Square Family Health and its Medical Director, Rachel Wheeler, MD. Cambridge Health Alliance, like East Boston Neighborhood Health Center, is fully electronic, using the EpicCare electronic health record.

The pictures (click on any to see full size):

Union Square, based in Somerville, serves a diverse community as East Boston does, with a large Brazilian community. I was able to shadow the practice of Francisco (Frank) Brincheiro, MD, a family medicine specialist who is also fluent in Portuguese for his patients of Brazilian descent. Frank has been using an electronic health record for two years and appears very comfortable with it. In the flow of his patient care, he showed his system for accurately placing orders, documenting care, and involving patients in care. The two visits that I observed were conducted mostly in portuguese, and I noticed a great rapport between patient and physician.

This medical center has undergone significant transformation very recently, with an increase of exam room count from 8 to 12, in part due to space reclamation from implementing the electronic health record. This medical center will also be piloting CHA’s personal health record in the near future. I asked Rachel and Frank about their feelings about this addition to their care. Both were positive, and added some important considerations. As Dr. Brincheiro will communicate with his patients in their native language electronically, this may impose challenges to workflows that involve staff that are not fluent. On the one hand, it seems the increased accuracy that comes from patients writing into their medical record is welcomed. On the other hand, this may impact participation of other members of the care team. It’s an interesting issue.

Following the session with Frank, Rachel again did the thing that I enjoy so much, walking me back to the main hospital. One thing that really impressed me about Rachel and Hilary’s outlook is that both felt that primary care is challenging, but neither felt that primary care is at its lowest point based on their experience. This was heartening to me, and also indicative of this organization’s commitment. In the PCHIT initiative, one of the premises is that every patient should have access to these resources, and organizations like Cambridge Health Alliance are on the leading edge of supporting that promise.

The conclusion of my visit was a presentation of the work of Group Health Cooperative to the Information Technology Steering Committee of Cambridge Health Alliance. We had a terrific discussion, and it was clear to me that the questions were about how to do this well for their community, rather than whether to do it.

I left this lovely city with the knowledge that I have thus far interacted with three safety-net health systems, Institute for Family Health, East Boston Neighborhood Health Center, and Cambridge Health Alliance, all with top notch technology, great care providers, and strong commitments to innovate. This has been one of the most exciting findings of my time in this initiative so far. Like the others, I think Cambridge Health Alliance will do great when they go live, for their patients and for themselves.

With great thanks to Drs. Worthen, Wheeler, Brincheiro, and the patients and staff at Cambridge Health Alliance for the gift of their time. Errors: is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype.

1 Comment

Ted Eytan, MD